NPIMap

Organization Active NPI

Elan Dental Group Lansing, PLLC

Doing business as Elan Dental Group

  • Dental Clinic/Center
  • East Lansing, MI
National Provider Identifier
1427595164
Registry record updated Jan 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
18235 Issued in MI
Legal business name
ELAN DENTAL GROUP LANSING, PLLC
Doing business as
Elan Dental Group
Practice address
1500 Abbott Rd Ste 120
East Lansing, MI 48823-1956
Phone
(517) 351-9540
Fax
(517) 351-1645
NPI assigned
Jan 19, 2017
Last updated
Jan 19, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sergio Mauricio Moeller Zevallos, DDS, MSNPI 1790970663
Title
Dentist
Phone
(734) 662-7874

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 18235 MI Primary

Addresses

Primary practice location

1500 Abbott Rd Ste 120
East Lansing, MI 48823-1956

Mailing address

2509 S State St
Ann Arbor, MI 48104-6145
Phone (734) 662-7874

Other names 1

  • Elan Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

1500 Abbott Rd
Ste 120
East Lansing, MI 48823
Phone (517) 351-9540

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484784000000",
    "number": "1427595164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2509 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481046145",
            "telephone_number": "734-662-7874",
            "fax_number": "734-662-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 ABBOTT RD STE 120",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488231956",
            "telephone_number": "517-351-9540",
            "fax_number": "517-351-1645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELAN DENTAL GROUP LANSING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-19",
        "last_updated": "2017-01-19",
        "status": "A",
        "authorized_official_last_name": "MOELLER ZEVALLOS",
        "authorized_official_first_name": "SERGIO",
        "authorized_official_middle_name": "MAURICIO",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "734-662-7874",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MI",
            "license": "18235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elan Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.